In a prospective cohort of high school and college athletes, those who had more psychosomatic symptoms before their injury had a longer recovery, according to Lindsay Nelson, PhD, of the Medical College of Wisconsin in Milwaukee, and colleagues.

But acute 24-hour post-concussive symptom burden was the best predictor of recovery, as those with higher symptom reporting were less likely to have a slower recovery, they reported online in Neurology.

"We found the greatest predictor of recovery after a concussion was the severity of early post-concussion symptoms," Nelson said. "But somatic complaints before injury also play an important role, either by possibly enhancing how a person experiences the injury or affecting their reporting of post-concussive symptoms."

There's been more interest in predicting how patients will recover from concussion, and the most consistent predictor has been early self-reported symptoms. But some patients still take longer to recover from concussion than predicted based on these factors.

More athletes are now having baseline scans done so they can track any changes if they do experience a concussion. Nelson and colleagues assessed a group of 2,055 high school and college athletes who had done just that. They were also evaluated before the start of the season for functional, psychological, and psychosomatic symptoms -- the latter of which were measured on the Brief Symptom Inventory-18 somatization scale.

Overall, 50% of the athletes had at least one of the psychosomatic symptoms.

During follow-up, 127 of them experienced concussion, and 80% were male. The majority (61%) were football players, followed by soccer players (24%), lacrosse (6%), wrestlers (3%), hockey (3%), rugby (2%), and field hockey (1%).

They also found that those with worse acute post-concussive symptoms as measured by the Sport Concussion Assessment Tool-3 (SCAT3) had a slower recovery (HR 0.49, P<0.001).

Although these two predictors were moderately correlated, the contribution of acute symptom burden was a better predictor of recovery than pre-injury psychosomatic symptoms.

"First, acute post-concussive symptom severity is the strongest postinjury predictor of recovery time," they wrote. "Second, pre-injury somatization symptoms play an important role in recovery by enhancing athletes' experience or reporting of post-concussive symptoms."

"These study findings point to somatization as a target for future research on the mechanisms underlying premorbid factors relevant to concussion recovery," Nelson and colleagues concluded. "These findings also have directly translational significance, suggesting that clinicians should assess psychological health factors in the management of athletes recovering from concussion."

In an accompanying editorial, David Loring, PhD, of Emory University in Atlanta, and Michael Makdissi, PhD, of Olympic Park Sports Medicine Center in Melbourne, Australia, agreed that pre-injury psychosomatic symptoms may eventually help to develop early interventions that can improve outcomes for patients who have a concussion.

"Of note, the degree of reported somatization by the large majority of participants in this sample was below the threshold typically used to infer clinically relevant somatization levels," they wrote. "This suggests that variability in somatization typically associated with normal functioning is nevertheless an important factor related to outcome duration."

The study was funded by the U.S. Army Medical Research and Materiel Command, the Clinical and Translational Science Institute, and the National Institutes of Health National Center for Advancing Translational Sciences.

The authors and editorialists declared no financial relationships with injury.

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